I guess the obvious question to get out of the way is did you feel any of your symptoms during any of the tests or when you wore the holter monitor?
That would be a negative. I felt something diagonal from my chest up to my shoulder during the stress test when I was at my target heart rate but they assured me it was probably something else. It felt like a sharp pain diagonal pain from the upper left corner of my chest and went upward towards my shoulder a few inches. It went away immediately when I started to cool down.
I guess it could be your anxiety but why would you get anxious towards the end of a stress test. A heart rate of 112 during exertion is nothing, I used to easily reach 186 and athletes can reach 200. Maybe you are experiencing vasospasm and this feels like angina and can be brought on by exertion or certain dietary foods. I would go back to your Doctors and not necessarily have a repeat of the tests, but maybe discuss vasospasm. In different people it feels different because the artery can be squeezed a different amount. So you have a huge range of someone having pinching pains to someone having a heart attack.I had vasospam a couple of years ago and i felt pinches in the left side of my chest. I was given medication which stopped the problem after 3 months and I have been fine since.
If not this, then it could be a vagus nerve issue. This nerve connects to everything in the body including the heart and if pinched in any way, it can give wierd results. I've had trapped gas which has irritated that nerve and given palpitations for example. So there are just 2 things to possibly think about.
Given family history, it is possible and plausible that you have a cardiovascular issue. You need to discuss the results with your physician. Firstly background as to why... I was diagnosed with 3 vessel coronary artery disease at 26 and had my first stent for a 75% block in my right coronary artery. Bad heart genetics on both side of my family. I have a genetic lipid disorder. Testing the type(s) and concentrations of lipids can help shed some light if you possibly have an aggressive lipid disorder.
An echo will yield little unless there is a clear problem--and even then it is up to the skill of the interpreter. However the test is valuable, and does set a baseline. EKGs are not definitive especially in diagnosing ischemia. A standard stress that is not a nuke stress adds little value for diagnosing young people as often times the workout is harder than the stress.
As ed34, coronary spasm could be blame. Vagus nerve malefaction as ed34 describes can play havoc on the heart. At sites of larger lesions if one has one, the site (one of the coronary arteries) could spasm. The only clear diagnostic for this issue is cardiac catheterization. I had chest pain early on in my life, along with hearth rhythm issues and frankly had an extremely difficult time with diagnosis having symptoms, severe family history, and worsening issue. Since that time of diagnosis about 13 years ago of 3 vessel moderate CAD, I've had 5 stents placed, on my second dual chamber pacemaker, 2 MI's and am now in heart failure (left ventricular diastolic dysfunction, combined systolic and diastolic heart failure . I was diagnosed with heart failure in 2013.
It is possible for young patients to have heart disease at a young age. As well, you can have valve pain. ER docs may say if you feel a sharp pain, or tearing pain, it isn't cardiac. Not true. Family history plays a huge rule. A younger patient's angina will differ from an older person. It's possible to have a heart attack and just fell tired--it may not be the full-on heart attack that's described as an obvious heart attack. It may be fatigue, chest pain, maybe a headache, maybe a jaw ache.
I would suggest you sit down with your family doc or cardiologist and discuss the tests and how you feel. Young CAD patients can be treated very poorly by some cardiologists and it can be dismissed as anxiety or some other psychological disorder. I would get another opinion, and I would find someone that specialized in CAD in young patients, or at least, has the brain power to review the symptoms and some testing. I had to claw my way through some misdiagnosis. Keep on the docs...keep questioning. You may have to work this as a diagnosis of exclusion through testing to rule every possible in or out, such as GERD. GERD (which I have) does not feel like angina, and it does not feel like a heart attack.
I wouldn't be alive today unless I kept pushing and pushing, 13 years after diagnosis. Again, work with your doc, and find a specialist. In searching for care, just because a hospital advertises themselves as being the best in heart care in the country does not mean they will solve your problem. Don't be discouraged. Good luck!